Usefulness of Preoperative Controlling Nutritional Status in Predicting Prolonged Hospitalization and Incidence of Postoperative Delirium for Elderly Hepatectomy with Hepatocellular Carcinoma

Usefulness of Preoperative Controlling Nutritional Status in Predicting Prolonged Hospitalization and Incidence of Postoperative Delirium for Elderly Hepatectomy with Hepatocellular Carcinoma

Atsushi Fujio,^1,2 Masahiro Usuda,¹ Yasuyuki Hara,¹ Yuta Kakizaki,¹ Kaoru Okada,¹ Go Miyata,¹ Michiaki Unno² and Takashi Kamei²

¹Department of Gastroenterological Surgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
²Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

The number of elderly patients with hepatocellular carcinoma (HCC) has been increasing, but it remains unclear whether hepatectomy can be performed using the same criteria as in younger patients. Furthermore, the appropriate preoperative evaluation for hepatectomy in elderly patients is not yet clearly defined. Here, we investigated the applicability of preoperative assessment using the Controlling Nutritional Status (CONUT) score to help improve hepatectomy outcomes in elderly patients with HCC. This was a single-center retrospective analysis, and the study population comprised 64 consecutive patients who underwent hepatectomy for HCC between January 2012 and August 2016. We compared the preoperative assessment and perioperative outcomes between elderly (≥ 75 years old) and younger (< 75 years old) patients. A total of 61 patients were reviewed. Poor preoperative CONUT score was associated with a longer postoperative hospital stay in elderly patients undergoing hepatectomy for HCC. In addition, although elderly patients had similar perioperative outcomes to younger patients, the incidence of delirium was significantly higher, and univariate analysis confirmed that old age is a risk factor for delirium among the preoperative factors. Hepatectomy for HCC in the elderly can be safely performed with appropriate preoperative nutritional assessment using CONUT score and prevention of postoperative delirium. Preoperative nutritional assessment using the CONUT score was useful in predicting prolonged hospitalization for elderly hepatectomy with HCC.

Keywords —— controlling nutritional status; delirium; elderly patients; hepatectomy; hepatocellular carcinoma

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Tohoku J. Exp. Med 2022, 256, 43-52.

Correspondence: Atsushi Fujio, M.D., Ph.D., Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi 980-0872, Japan.

e-mail: wisteriatail@surg.med.tohoku.ac.jp